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Dapagliflozin vs empagliflozin at doses of 500 mg/kg/day and 200 mg/kg/day, respectively, in 6-month-old and 12-month-old children with an age difference of 6 months. Efficacy was not significantly different than when placebo was given as a single dose (24; p = 0.087). Efficacy was also not significantly different than when empagliflozin was given as a single dapagliflozin zulassung deutschland dose (24; p = 0.067) and 200 mg/kg/day (21; p = 0.037) (24; 0.11). The efficacy of empagliflozin in a 7-year-old patient with CD (who has received a number of other therapies in the past, including a course of diclofenac and topical glucocorticoids) was similar to daptomycin (24; p = 0.7). Efficacy was not Betamethasone valerate cost significantly different than a placebo (24; p = 0.36) 0.23). DISCUSSION Although there is much confusion about the use of anticonvulsants in children with CD, there is good evidence that anticonvulsants are effective in reducing seizures a substantial number with CD. Most studies have not looked at optimal dose; therefore, we have used recommended doses rather than the usual adult doses of these medications. In contrast, the use of anticonvulsants in pediatric population presents major challenges, especially in regard to dose selection (as discussed previously) and compliance in the following section) (25–27). There are important differences between the pediatric CD patient population and the adults with CD who are considered at high risk for anticonvulsant drug adverse effects. Children and adolescents are much more likely to be diagnosed with CD than adults CD. One major problem in assessing the efficacy of pediatric population is that, in many cases, no reliable seizure data are available for the patients. A number of studies have been conducted to assess the efficacy of anticonvulsants in pediatric patients with CD. However, these studies are less than definitive. For instance, a study of 17 pediatric patients with CD revealed only a statistically significant reduction in seizure burden (24,30) and also showed a difference in treatment effect by CD grade (31). Moreover, in many pediatric clinical trials there was a dropout rate of as much 60% at the end of observation period; patients who dropped out did not receive additional doses during the course of study. Some these studies have focused on the efficacy of anticonvulsants in children with different developmental forms of CD, so that the same medication (i.e., anticonvulsants of the same class) might also be administered in different pediatric populations. These studies have shown that different classes of anticonvulsants have a different efficacy profile in pediatric populations. For instance, the efficacy was similar for diclofenac, diclofenac plus topiramate, esomeprazole, and loxiglumide, in both adults pediatric patients with CD, although the efficacy was lower in pediatric patients with more severe disease (32–33), but was similar in pediatric patients with less severe disease (34,35). These results clearly indicate that, while anticonvulsants may have an increased efficacy in some populations, this might not translate into clinically important differences in seizure control. For instance, Betamethasone dipropionate ointment 1 a recent study comparing anticonvulsants in children with various types of CD, a significant reduction was observed in the incidence of seizure patients on carbamazepine (33). It has been proposed that the increased seizure control for most severe forms of CD might also result in a reduced incidence of adverse events; however, the lack of a consistent pattern in the incidence of adverse events indicates a lack of evidence to recommend an increased treatment response for these patients. There currently are no FDA-approved monotherapy anticonvulsant drugs available to treat pediatric patients with CD. Some other drugs (e.g., carbamazepine monotherapy, topiramate and phenytoin monotherapy) may be useful but might have adverse effects and are not effective treatments for the majority of pediatric patients with CD, since their side effects may be dose-dependent and vary their efficacy might with the severity of disease on clinical assessment (1). In a recent, well-done study of the seizure outcomes in adolescents with CD, phenytoin was found to be a safe and highly efficacious monotherapy (36). For the vast majority of patients, phenytoins are not effective in the long-term and efficacy of phenytoin in patients with severe and refractory pediatric CD was much lower than in adults, suggesting that the anticonvulsant drug might prove to be ineffective as a monotherapy in the pediatric population (36).



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